Symptoms and Tests
Most cancers in their early, most treatable stages don't cause any symptoms. Early prostate cancer usually does not cause symptoms.
However, if prostate cancer develops and is not treated, it can cause these symptoms:
- a need to urinate frequently, especially at night
- difficulty starting urination or holding back urine
- inability to urinate
- weak or interrupted flow of urine
- painful or burning urination
- difficulty in having an erection
- painful ejaculation
- blood in urine or semen
- pain or stiffness in the lower back, hips, or upper thighs.
Any of these symptoms may be caused by cancer, but more often they are due to enlargement of the prostate, which is not cancer.
If You Have Symptoms
If you have any of these symptoms, see your doctor or a urologist to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system. The doctor will ask questions about your medical history and perform an exam to try to find the cause of the prostate problems.
The PSA Test
The doctor may also suggest a blood test to check your prostate specific antigen, or PSA, level. PSA levels can be high not only in men who have prostate cancer, but also in men with an enlarged prostate gland and men with infections of the prostate. PSA tests may be very useful for early cancer diagnosis. However, PSA tests alone do not always tell whether or not cancer is present.
PSA screening for prostate cancer is not perfect. (Screening tests check for disease in a person who shows no symptoms.) Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer. Also, the digital rectal exam can miss many prostate cancers.
The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope.
If Cancer is Present
If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.
One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.